Sambit Ku Panda

Introduction: Legg calves Perthes disease (LCPD) is caused mainly due to idiopathic osteonecrosis or AVN of the proximal femoral epiphysis leading to remodelling during period of development, this will gradually progress into onset of hip osteoarthritis depending upon the rate at which the sphericity and congruency of the femoral head deteriorate. LCPD is usually associated with a hinge abduction deformity, in this condition the major aspherical portion of the head is shifted laterally, in such deformity; Valgus intertrochanteric osteotomy has to been utilized for correction. Cheilectomy deals with excision of exuberant portion of femoral head epiphysis, thereby eliminating hinged abduction and facilitating containment, which also maintains the blood supply, buy protecting the surrounding soft tissue structures. Materials and Methods: We have included 10 patients for this study, from age group 9-16yrs, between July 15th to April 18. The criteria for patient selection being primarily adolescent age with radiological evidence of LCPD, with coxa plana and decreased range of motion. Patient under 10 years of age and with history of previous surgeries have been excluded. All the patients were planned preoperatively and operated under spinal anaesthesia. Through posterior kocherlangenback approach, capsulotomy was doneposterior-superiorly and lateral protuberance was identified and excised. A common feature through most surgeries being femoro-acetabular impingement (CAM type) secondary to aspherical femoral head. There were a total of 7 cases of complex CAM type deformities and 3 pincer induced deformities. Postoperatively weight bearing and ROM was restricted for 4 weeks. Physiotherapy protocol was followed for improving ROM. Patients were followed at 4,8,12 weeks to evaluate clinical and radiological progress. Results: Majority of the patient experienced improved pain after surgical intervention and 1 patient had worsening of pain at 3 months of followup. 2 patients had complication of delayed wound healing due to superficial infections. No further complications such as osteonecrosis and non-union were not observed. Conclusion: Though this study we can conclude that osteochondroplasty of the femoral head and neck performed in conjunction with other procedures, through the surgical dislocation of hip approach has improved pain and restored function in a majority of the patients, while avoiding any dreaded complications. Although the results were satisfactory in a 3 month follow up, we may conclude that a long term follow up is needed for the efficacy of this method in restoration of painless joint function and avoidance of arthroplasty at a later date. Keywords: Surgical dislocation, Kocher – langenback approach, Perthes disease, Osteochondroplasty

Materials and Methods: Analysis of eighty patients with periarthritis shoulder was done. Patients were thoroughly evaluated and were divided into two groups in a randomized trial. Forty patients were in group-A who received 3doses of injection of PRP (4ml) 2 weeks apart within a duration of 6weeks. Equal number of patients were in group-B. They received 2ml of Injection corticosteroid 2weeks apart within a duration of 6 weeks. All participants were advised to perform a home-based hot fomentation and 15min exercise therapy. One participant from group A and 2 from group B were lost to follow up. There were 35 male and 42 female who completed the study. Analysis of 77 subjects who completed the study was done. Participant were evaluated for range of motion of shoulder as main outcome measure. Visual Analogue Scale (VAS) and (Quick DASH) was used to measure pain and functions of the shoulder. The evaluation of Participants was done at 0,3,6 and 12 weeks. ANOVA test and Chi-square test, was repeatedly used to measure the differences. Results: Participants who were given PRP injections showed significant improvements in active and passive range of shoulder motion as measured by VAS and Quick DASH over corticosteroid injection. This was also reflected statistically. No major adverse reactions were observed during 12 weeks of intervention. Conclusion: In our study, the injection of PRP showed marked improvement in the range of motion of shoulder over corticosteroid injection but it needs other study to be treatment of choice. It emerged as an option for treatment in diabetes patient and condition where steroid is contraindicated. Keywords: Platelet Rich Plasma Injection, Corticosteroid Injection, Efficacy, Periarthritis Shoulder

Background: Radial head fractures are the most frequent fracture type reported around the elbow. Fractures have been documented to occur in isolation or with other associated osseous and soft tissue injuries. However, despite intensive research into these injuries, controversies still exist regarding the role of further imaging modalities, the use of non-operative management, as well as the indication and technique for operative intervention. Aims and Objective: To analyses the clinical and functional outcome of patients with head and neck fracture of radius managed by conservative method, open reduction and internal fixation, radial head prosthesis and radial head excision. Materials and Methods: This study “evaluation of results of fracture head and neck of radius managed by various methods” was carried out in M.K.C.G Medical College, Berhampur from September 2017 to October 2019. Eighty patients of radial head and neck fractures were treated and hereby included in our study. We collected records of the patients by asking the patients history and examining the patients. Essential investigations of all the patients were done. The primary outcome measures were the surgeon reported Mayo Elbow Score (MES) and the patient reported Short Musculoskeletal Function Assessment (SMFA). Conclusion: Current evidence supports open reduction and internal fixation of simple Mason type II fractures. For Mason type III fractures, controversy still exists regarding the optimal treatment. Studies currently show good to excellent results with radial head replacement in the majority of patients with Mason type III fractures with three or more fracture fragments.   Keywords: Radial Head Arthroplasty, Herbert’s screw, Radial head excision

Background: Neuropathic pain (NeP) is caused by a disease like lesion; it is the disease of the somatosensory nervous system. NeP also caused some severe health disorders such as diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and spinal cord injury (SCI). Along with the severe health issues, NeP adversely affects the quality of life (QOL) as well as an economic burden on the infected persons and their family plus society. Aim: The aim of the study is to define the efficiency of pregabalin for the treatment of moderate or severe baseline neuropathic pain at a tertiary care centre in Ganjam, Odisha. Materials and Methods: It was a randomized study conducted between August 2019 and January 2020 at the MKCG Medical College Berhampur, Ganjam, Odisha on 700 patients. Simple randomization technique was employed to give patients either pregabalin or placebo. All the patients aged >18 years were selected for the study. The pain was assessed for all the patients using the 11-point numeric rating scale, where 0 = no pain and 10 = worst possible pain. All the patients having pain score >4 were involved in the study. Patients who were below 18 years of age were omitted from the study. Further, the patients whose pain score was below four were also omitted from the study. Results: It was observed that there were 455 patients in the Pregabalin group, and in the placebo group, there were 245 patients. The patients were also bifurcated as per the severity of their discomfort, in which 513 patients were comprised in the moderate section, whereas 187 patients were encompassed in the severe section. 63-71 years was the median age. In the moderate and severe pain group, standard mean pain scores were equivalent among the pregabalin and placebo treatment groups. There was a statistically significant difference among both the groups with respect to the change in pain score. This implies that pregabalin reduced pain more significantly as compared to the placebo group. The above table also depicted the improvement in mean sleep scores as well. There was a statistically significant difference among both the groups with respect to the sleep scores. The sleep score in the pregabalin group improved from the baseline to endpoint more significantly as compared to the placebo group. In the moderate to severe pregabalin group, 90% of the patients experienced at least one treatment-emergent as compared to 70% in the placebo group. The most common side effects of the AE were weight gain, dizziness, and peripheral edema. The highest discontinuation from the study was observed in the pregabalin group. Conclusion: It was found that the pregabalin was effective in terms of reducing pain and had greater tolerability with the patients. It was also identified that the patients in the severe pain segment shifted to mild segment with the use of pregabalin dosage. Keywords: Neuropathic Pain, Pregabalin, Placebo.

Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci.  Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.7210.85 years, and that of group 2 patients was 46.408.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 0.351 and in group 2 was 3.1 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 2.09 and in group 2 was 13.04 2.28 (p>0.05). The mean functional score of group 1 was 91.212.27, and in group 2, it was 8718.2 (p>0.050). In group1 mean WOMAC score was 12.2 21.179, and in group 2 was 16.72  16.923 (p>0.05). 2 patients had hypertension, and none of the patients had diabetes. While in group two, three patients had diabetes, and two patients had hypertension. Conclusion: In the light of the aforementioned results, it was found in the surgical and functional outcomes of both unicondylar and bicondylar fractures of the proximal tibia are satisfactory and comparable to each other. Furthermore, it was identified that Factors such as age, gender and the fracture type did not influence the outcome in both the study groups. Additionally, most fractures occurred in the middle age group with male preponderance in both unicondylar and bicondylar fractures. Keywords: Proximal Tibia Fractures, Unicondyla fractures, Bicondylar Fractures.